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Otherwise known as Gastroscopy, this is an examination of the inside of the upper digestive system. It looks at the oesophagus, stomach and the first part of the small intestine called the duodenum. It is usually used to investigate symptoms such as difficulty in swallowing, heartburn, abdominal, nausea and vomiting. The procedure usually takes no longer than 15 minutes.
This procedure examines the large intestine or colon and can also examine the last part of the small intestine, called the terminal ileum, that joins the large intestine. The colonoscope is passed into your large intestine through your back passage. The examination usually takes 15 to 30 minutes, depending on how long, looped or kinked your large intestine is. This test is done to investigate bleeding from the back passage, changes in bowel habits, abdominal pain and to screen for polyps and colon cancer.
Enteroscopy of the small bowel
The more common examinations by Gastroscopy and Colonoscopy would be able to diagnose the majority of the problems of the digestive system. The small intestine is 6 m long. The first and second parts of the duodenum in the upper digestive tract as well as the terminal ileum that joins the colon are easily accessed. However the middle part of the small intestine is more difficult to examine. Balloon Enteroscopy is performed by a special endoscope which is fitted with a sheath which has an inflatable balloon at one end. By a process of inflating and deflating the balloon while moving the endoscope, the endoscope can reach from one end of the small intestine to the other end. The endoscope can be introduced either through the mouth or through the back passage, depending on where the problem is suspected to be. This method is used to investigate anaemia or bleeding, suspected tumours in the small intestine or inflammatory bowel disease, typically Crohn’s Disease.
Capsule Endoscopy of the small bowel
The small intestine is examined by means of a high-tech capsule the size of a large vitamin pill, which contains camera, lights, lenses and a radio transmitting device. It is swallowed and as it moves through the small intestines, pictures are taken at a rate of two per second. The Capsule transmits images to a recorder worn during the duration of the test and these thousands of images can be downloaded to a computer to be studied in detail. The capsule then passes harmlessly in the stools. The advantage of Capsule Endoscopy is that it is non-invasive and the pictures can be very clear. However it is not possible to take biopsies of lesions seen, or do any therapeutic treatment such as stopping a bleeding site.
Endoscopic Retrograde Cholangio-Pancreatography (ERCP)
This endoscopic examination method is used to examine the bile ducts, which connect the liver to the small intestine and the pancreas. The endoscope is a side viewer called a Duodenoscope and is passed through the mouth, past the stomach and into the second part of the upper small intestine or duodenum. The Ampulla of Vater, which is the entrance to the bile and pancreatic ducts, is located and a catheter is used to enter the common bile duct or pancreatic duct. Contrast (a dye that is visible on x-ray) is injected and by Fluoroscopy (live, real-time x-ray scanning) these ducts can be examined. This examination is done if the bile ducts are thought to be blocked by gallstones or a tumour.
Liver biopsy may be performed to diagnose inflammation, liver scarring (cirrhosis), cancerous or non-cancerous growths or some infections in the liver. Liver biopsy involves removing a tiny piece of liver tissue under a local anaesthetic, using a special liver biopsy needle. The specimen is then sent for pathological examination. Ultrasound scanning is commonly used to locate the best and safest place to insert the biopsy needle.